Preemptive Kidney Transplant

A preemptive kidney transplant is a surgical procedure where a patient receives a kidney transplant before starting dialysis, typically when their kidney function has declined to a certain level but they are still asymptomatic or have minimal symptoms.

Benefits of Preemptive Kidney Transplant

• Avoidance of dialysis and its associated complications, such as vascular access infections and cardiovascular disease
• Better preservation of residual kidney function
• Improved quality of life and reduced risk of mortality
• Reduced risk of sensitization to human leukocyte antigens (HLA), which can make it more difficult to find a compatible donor in the future
• Potential for improved graft survival and function

Candidates for Preemptive Kidney Transplant

Patients with end-stage renal disease (ESRD) or those with progressive kidney disease who are likely to require dialysis in the near future may be candidates for a preemptive kidney transplant. This includes patients with:

• Chronic kidney disease stage 4 or 5
• Glomerular filtration rate (GFR) below 20 mL/min/1.73m²
• Progressive kidney disease, such as focal segmental glomerulosclerosis (FSGS) or polycystic kidney disease (PKD)

Evaluation Process

Prior to a preemptive kidney transplant, patients undergo a comprehensive evaluation, including:

• Medical history and physical examination
• Laboratory tests, such as blood work and urinalysis
• Imaging studies, such as ultrasound or CT scans
• Cardiovascular evaluation, including echocardiogram and stress test
• Psychosocial evaluation

Surgical Procedure

The surgical procedure for a preemptive kidney transplant is similar to that of a standard kidney transplant. The donor kidney is typically placed in the lower abdomen, and the patient's native kidneys are usually left in place.

Post-Transplant Care

After a preemptive kidney transplant, patients require close monitoring and follow-up care to ensure the graft functions properly and to prevent complications. This includes:

• Immunosuppressive medication to prevent rejection
• Regular laboratory tests to monitor kidney function and adjust medication as needed
• Clinical follow-up appointments with the transplant team